Profile of adverse events in toxoplasmosis drug therapy: a review




Drug-related side effects; Adverse reactions; Drug therapy; Toxoplasmosis; Pyrimethamine.


This study aims to analyze the profile of adverse events (AEs) of drugs for the treatment of Toxoplasmosis. This is a review carried out through a bibliographic search in the electronic databases PubMed, SciELO, Cochrane Digital Library and LILACS. The keywords “Toxoplasmosis” AND “Drug Therapy” AND “Drug-Related Side Effects and Adverse Reactions” were used. The selection was performed by two independent reviewers and the articles were included considering the presence of retrospective studies and case reports published in the literature in Portuguese and English and without time restrictions. In total, 40 articles were found, of which 14 met the inclusion criteria. Cases of cerebral, ocular, gestational and congenital Toxoplasmosis were identified. Among these, we observed a total of 85 patients with reports of AEs due to the use of Pyrimethamine, Sulfadiazine, Spiramycin, Clindamycin, Atovaquone, Trimethoprim and Sulfamethoxazole and Sulfadoxine. Clinical reactions were in the form of skin rash (57.1%), hematological alterations (28.5%), Lyell syndromes (7.1%), Stevens-Johnson (21.4%) and DRESS (21 .4%). The prevalence of AEs related to hematological alterations was seen mainly in treatments based on Pyrimethamine + Sulfadiazine, Trimethoprim and Sulfamethoxazole; on the other hand, those associated with severe syndromes are often related to the use of Pyrimethamine + Sulfadiazine. It is important to establish a standard protocol for drug therapy for Toxoplasmosis, which does not yet exist. In addition, the need to monitor patients after drug administration is highlighted, given the possibility of the occurrence of adverse events that can represent a threat to life.

Author Biographies

Karlla Mayara Nunes de Sousa, University of Pernambuco

Post Graduate student of Post Graduate Program in Applied Cellular and Molecular Biology/Institute of Biological Sciences/University of Pernambuco/Pernambuco/Brazil

Amanda Carla Corrêa Viana, University of Pernambuco

Graduation Student of Medical Sciences Faculty, University of Pernambuco (UPE)/Pernambuco/Brazil

Silvana de Fátima Ferreira da Silva Caires, University of Pernambuco

Professor of Biological Science Institute/University of Pernambuco (UPE)/ Pernambuco/Brazil

Raquel Pedrosa Bezerra, Rural Federal University of Pernambuco

Professor of Department of Morphology and Animal Physiology, Rural Federal University of Pernambuco (UFRPE)/ Pernambuco/Brazil

Edmilson Mariano de Sousa Júnior, Federal University of Pernambuco

Post Graduation student of Department of Tropical Medicine. Hospital das Clínicas/ Federal University of Pernambuco/ Pernambuco/Brazil.

Daniela de Araújo Viana Marques, University of Pernambuco

Laboratório de Biotecnologia Aplicada a Doenças Infecto-Parasitárias.


Alday, P., & Dogget, J. (2017). Drugs in development for toxoplasmosis: advances, challenges, and current status. Drug Design, Development and Therapy, 11, 273-279.

Ben-Harari, R., Goodwin, E., & Casoy, J. (2017). Adverse event profile of pyrimethamine-based therapy in toxoplasmosis: A systematic review. Drugs in R&D, 17, 523-544.

Bernardo, W., Chinzon, M., & Chaves, F. (2015) Is sulfadiazine alone equivalent (benefit and harm) to spiramycin to treat acute toxoplasmosis in the first trimester of pregnancy? Revista da Associacao Medica Brasileira, 61, 495-496.

Canessa, A. et al. (1992) Cotrimoxazole therapy of Toxoplasma gondii encephalitis in AIDS patients. European Journal of Clinical Microbiology and Infectious Diseases, 11, 125-130.

Carrión-Carrión, C. et al. (1999) Fatal Stevens–Johnson syndrome in an AIDS patient treated with sulfadiazine. Annals of Pharmacotherapy, 33, 379-380.

Caumes, E. et al. (1995) Adverse cutaneous reactions to pyrimethamine/sulfadiazine and pyrimethamine/clindamycin in patients with AIDS and toxoplasmic encephalitis. Clinical Infectious Diseases, 21, 656-658.

Deng, Y. et al. (2019) Recent progress on anti-Toxoplasma drugs discovery: design, synthesis and screening. European Journal of Medicinal Chemistry, 183, 111-711.

Dunay, R. et al. (2018) Treatment of toxoplasmosis: historical perspective, animal models, and current clinical practice. Clinical Microbiology Reviews, 31.

Franco, P. et al. (2019) Brazilian strains of Toxoplasma gondii are controlled by azithromycin and modulate cytokine production in human placental explants. Journal of Biomedical Science, 26, 1, 10.

Guaraldo, L. et al. (2018) Ocular toxoplasmosis: adverse reactions to treatment in a Brazilian cohort. Transactions of the Royal Society of Tropical Medicine and Hygiene, 112, (4)188-192, 2018.

Hedriana, H. et al. (1993) Normal fetal outcome in a pregnancy with central nervous system toxoplasmosis and human immunodeficiency virus infection. A case report. The Journal of Reproductive Medicine, 38, 747-750.

Helfenstein, M. et al. (2017) Ocular toxoplasmosis: therapy-related adverse drug reactions and their management. Klinische Monatsblatter Fur Augenheilkunde, 234, 556-560.

Iaccheri, B. et al. (2008) Adverse drug reactions to treatments for ocular toxoplasmosis: a retrospective chart review. Clinical Therapeutics, 30, 2069-2074.

Karakayalı, B. et al. (2017) Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) syndrome associated with cefotaxime and clindamycin use in a 6 year-old boy: a case report. Pan African Medical Journal, 28, 218.

Kim, P., Younan, N., & Coroneo, M. (2002) Hypersensitivity reaction to intravitreal clindamycin therapy. Clinical and Experimental Ophthalmology, 30, 147-148.

Marcos, C. et al. (1995) Clindamycin desensitization in an AIDS patient. AIDS, 9, 1201-1202.

Mcleod, R. et al. (2006) Severe sulfadiazine hypersensitivity in a child with reactivated congenital toxoplasmic chorioretinitis. The Pediatric Infectious Disease Journal, 25, 270-272.

McKenzie JE. et al (2021). The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ, 71, 372.

Nucera, E. et al. (2000) Tolerance induction to cotrimoxazole. Allergy, 55, 681-682.

Oliveira, C. (2012) Evaluation of anti-toxoplasmic, antioxidant and anti-inflammatory activities of Thymol (Lippia sidoides) and Estragole (Croton zenhtneri) [Dissertation]. Federal University of Rio Grande do Norte.

Ostlere, L., Langtry, J., & Staughton, R. (1991) Allergy to spiramycin during prophylactic treatment of fetal toxoplasmosis. BMJ, 302, 970.

Paradynski, G. et al. (2019) Health care actions through biomedical professionals in the diagnosis and prevention of Toxoplasmosis. Revista Integrada Saúde, 12, 140-152.




How to Cite

SOUSA, K. M. N. de .; VIANA, A. C. C. .; CAIRES, S. de F. F. da S.; BEZERRA, R. P.; SOUSA JÚNIOR, E. M. de .; MARQUES, D. de A. V. . Profile of adverse events in toxoplasmosis drug therapy: a review. Research, Society and Development, [S. l.], v. 10, n. 13, p. e505101321339, 2021. DOI: 10.33448/rsd-v10i13.21339. Disponível em: Acesso em: 6 dec. 2021.



Review Article